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Virginia Bowen, MHS Amy Paul, MPH
Joanne Rosen, JD, MA
October 17, 2012
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Overview Snapshot of American abortion Differentiate counseling and consent terms Review practices of licensed abortion facilities
Laws governing licensed abortion facilities Review practices of crisis pregnancy centers
Laws governing crisis pregnancy centers Ethical dilemmas of counseling and consent Discussion, questions
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Abortion in the U.S. Of the 6.6 million annual pregnancies, 19%
result in induced abortion 89% of all abortions occur during the first 12
weeks of pregnancy
Jones, Finer, & Singh (2008)
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U.S. Abortion by Age
20-24 25-29
30-34
15-19 35-39
Jones, Finer, & Singh (2008)
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Abortion in the U.S. 61% of abortions are obtained by women
who have one or more children 42% of abortions are to women whose
incomes are less than 100% of the federal poverty line
45% of abortions are to never-married, not cohabiting women
Jones, Finer, & Singh (2008)
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Counseling vs. Informed Consent
Options Counseling
Abortion Counseling
Abortion Procedure Informed Consent
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Counseling vs. Informed Consent
Crisis Pregnancy Centers
Licensed Abortion Facilities
•Options Counseling •Abortion counseling
•Abortion procedure informed consent
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Licensed Abortion Facilities Abortion Counseling Informed Consent for Abortion Procedure
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Legal Mandates for Licensed Abortion Facilities Informed consent from a legal perspective Special legal requirements in the case of
abortion Vary widely by state Maryland abortion law Other state counseling/consent laws
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Crisis Pregnancy Centers What are they? What services do they offer? “Medical” services Options counseling
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CPCs and the Law Recent developments in the regulation of CPCs
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Ethical Basis of Informed Consent
Bioethical principles in medical ethics: Autonomy or Respect for Persons Beneficence Justice
Informed consent as a reaction to heavily paternalistic practice of medicine
Goal: informed decision-making and self-determination
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What information should be disclosed? Minimum requirements include statement of risks,
benefits, alternatives – what else? Specific language mandates? Should women ever be able to opt-out of information
disclosure?
When does information/disclosure shift from being autonomy enhancing to paternalistic or even coercive?
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Striking a Balance
Practical Ethical
Political
Autonomy Infringement
Autonomy enhancement
Autonomy Infringement
No interference Soft Paternalism Coercion?
No information Some information
Too much information?
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Potential Sources of Coercion Information itself Status of person providing consent Environment Sense of urgency
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Is Abortion Different? Does informed consent for abortion require new or
modified guidelines?
Are the challenges of achieving informed decision-making because of the unique characteristics of abortion, or are they symptomatic of broader deficiencies in current medical practice?
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Discussion